• Convolutional neural network (CNN)
• Diagnosis
• ONFH classification
• Osteonecrosis of the femoral head (ONFH)

• 2021 National Orthopedics and Sports Rehabilitation Clinical Medical Research Center Innovation Fund Project

• Non-traumatic osteonecrosis
• etiology
• molecular target
• pathogenesis
• pharmacologic intervention

• Animals
• Humans
• Inflammation/drug therapy
• Inflammation/physiopathology
• Lipid Metabolism/drug effects
• Molecular Targeted Therapy/methods
• Osteonecrosis/drug therapy
• Osteonecrosis/etiology
• Osteonecrosis/physiopathology

• HEBP1
• Mendelian randomization
• genome-wide association studies
• osteonecrosis
• plasma proteins

• Exosome
• Ferroptosis
• Orthopedic
• Target point
• Treatment

• Ferroptosis/physiology
• Humans
• Exosomes/metabolism
• Animals
• Iron/metabolism

• Meta-analysis
• Osteonecrosis of the femoral head
• Randomized controlled trial
• Systematic review
• Traditional Chinese medicine

• Humans
• Femur Head
• Femur Head Necrosis/surgery
• Medicine, Chinese Traditional
• Treatment Outcome

• Avascular necrosis
• Bibliometrics
• Femoral head
• Hip
• Osteonecrosis
• Scientometrics

• angiogenesis
• biomaterials
• bone resorption
• early osteonecrosis of the femoral head
• osteogenesis

• Osteonecrosis of the femoral head, osteocyte apoptosis
• Signal pathway
• Traditional Chinese medicine

• core decompression
• hemiarthroplasty
• hip osteonecrosis
• osteotomy
• surgical trends
• total hip arthroplasty

Celecoxib has been used to treat hip discomfort and functional difficulties associated with osteonecrosis of the femoral head (ONFH), although significant adverse reactions often follow long-term use. Extracorporeal shock wave therapy (ESWT) can delay the progression of ONFH, alleviate the pain and functional limitations it causes, and avoid the adverse effects of celecoxib.

To investigate the effects of individual ESWT, a treatment alternative to the use of celecoxib, in alleviating pain and dysfunction caused by ONFH.

This was a randomized, controlled, double-blinded, non-inferiority trial. We examined 80 patients for eligibility in this study; 8 patients were excluded based on inclusion and exclusion criteria. A total of 72 subjects with ONFH were randomly assigned to group A (n = 36; celecoxib + alendronate + sham-placebo shock wave) or group B (n = 36; individual focused shock wave [ESWT based on magnetic resonance imaging three-dimensional (MRI-3D) reconstruction] + alendronate). The outcomes were assessed at baseline, at the end of treatment, and at an 8-wk follow-up. The primary outcome measure was treatment efficiency after 2 wk of intervention using the Harris hip score (HHS) (improvement of 10 points or more from the baseline was deemed sufficient). Secondary outcome measures were post-treatment HHS, visual analog scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores.

After treatment, the pain treatment efficiency of group B was greater than that of group A (69% vs 51%; 95%CI: 4.56% to 40.56%), with non-inferiority thresholds of -4.56% and -10%, respectively. Furthermore, the HHS, WOMAC, and VAS scores in group B dramatically improved during the follow-up period as compared to those in group A (P < 0.001). After therapy, the VAS and WOMAC in group A were significantly improved from the 2^nd to 8^th wk (P < 0.001), although HHS was only significantly altered at the 2 wk point (P < 0.001). On the 1^st d and 2^nd wk after treatment, HHS and VAS scores were different between groups, with the difference in HHS lasting until week 4. Neither group had severe complications such as skin ulcer infection or lower limb motor-sensory disturbance.

Individual shock wave therapy (ESWT) based on MRI-3D reconstruction was not inferior to celecoxib in managing hip pain and restrictions associated with ONFH.

• Extracorporeal shockwave therapy
• Osteonecrosis of femoral head
• Pain
• Magnetic resonance imaging three-dimensional reconstruction
• Celecoxib

• Comparative study
• Deep circumflex iliac artery
• Iliac bone flap
• Osteonecrosis of the femoral head
• Transplant

• gene polymorphism
• genetic engineering
• growth factor
• osteonecrosis of the femoral head
• tissue engineering

• Bone turnover marker
• Collapse
• Impact strength index
• Prediction
• Steroid-associated Osteonecrosis of the Femoral Head

• bone
• bone quality and biomechanics

• 81672173 National Natural Science Foundation of China (National Science Foundation of China)
• 82072448 National Natural Science Foundation of China (National Science Foundation of China)
• Key Research Development Program of Shaanxi Province, 2018ZDCXL-SF-28-7

• bibliometric analysis
• current status
• global trends
• osteonecrosis of the femoral head
• the last 30 years

• Bibliometrics
• Femur Head
• Humans
• Osteogenesis
• Osteonecrosis
• Publications
• United States

This study was designed as a cohort study using propensity-score matching to age, gender, and body mass index (BMI) for finite element model (FEM) analysis from pre-collapse CT images of collapsed and non-collapsed hips. Through FEM analysis, a global graphical output around the hip joint can provide simple impression of stress distribution: concentration or dispersion.

A total of 32 hips with ARCO stage 2 or 3 ONFH who were on follow up for over a one-year period were retrospectively reviewed. 16 hips with no interval progression of collapse were set as the study group, then 16 hips with progression of collapse which required arthroplasty were set as the control group using propensity-score matching. FEM was generated through Mechanical Finder for each patient, then 4500 N of load was applied to 1000 mm² area at the top of iliac crest to analyze the models in terms of equivalents for yield stress.

Age, sex, and BMI had no significant differences between the two groups, while location (p = 0.015) was lateral, and size (p = 0.015) was significantly greater in the collapsed group. Non-collapsed hips mostly exhibited stress dispersion allocated to medial and lateral pillars, while collapsed hips exhibited stress concentration focused on the lateral pillar and the primary compression trabecula. (p = 0.001).

Through FEM analysis, stress concentration to the lateral pillar and the primary compression trabeculae can be used to predict future collapse in ONFH with high probability. Results provide a simple and intuitive, yet valuable information to aid surgeons. Therefore, especially for young patients, holding out the lateral pillar through joint preserving procedures might be the key in preventing further collapse.

• Femoral head collapse
• Finite element analysis
• Lateral pillar
• Osteonecrosis of the femoral head
• Propensity-matched score

Femoral head osteonecrosis in the paediatric population is difficult to treat, with the primary goals of management being prevention of subchondral collapse and the avoidance of early total hip replacement. This study aims to describe the use of a porous tantalum rod implant to provide mechanical support in preventing femoral head collapse in a paediatric population. A retrospective chart-based analysis of patients with osteonecrosis of the hip was performed at our institution to identify those who had undergone tantalum rod insertion. A total of 10 patients (fives males and five females, median age 12.5 years, 9–18) had tantalum rods implanted between December 2013 and February 2018. One patient was excluded due to follow-up at a different institution. The radiographic degree of osteonecrosis was characterized according to the Ficat classification and the Kerboul angle. Radiographic assessment of pre- and post-operative plain films was performed. The outcome measures were Tonnis grade and percentage collapse of the femoral head. Nine patients with a mean follow-up time of 18.4 months were included in the analysis. There was no significant increase in the femoral head collapse percentage post tantalum rod insertion compared to pre-operatively (P = 0.63). There was a significant increase in the Tonnis grade post-operatively (P < 0.05), with sub-group analysis showing minimal increase in Ficat Stage 1 patients. This study is the first to examine the role of tantalum rod insertion in preventing femoral head collapse in a paediatric population, with results suggesting potential benefit in a subset of patients.

Pain, a major symptom of osteonecrosis of the femoral head (ONFH), is a complex sensory and emotional experience that presents therapeutic challenges. Pain can cause neuroplastic changes at the cortical level, leading to central sensitization and difficulties with curative treatments; however, whether changes in structural and functional plasticity occur in patients with ONFH remains unclear.

A total of 23 ONFH inpatients who did not undergo surgery (14 males, nine females; aged 55.61 ± 13.79 years) and 20 controls (12 males, eight females; aged 47.25 ± 19.35 years) were enrolled. Functional indices of the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and a structural index of tract-based spatial statistics (TBSS) were calculated for each participant. The probability distribution of fiber direction was determined according to the ALFF results.

ONFH patients demonstrated increased ALFF in the bilateral dorsolateral superior frontal gyrus, right medial superior frontal gyrus, right middle frontal gyrus, and right supplementary motor area. In contrast, ONFH patients showed decreased ReHo in the left superior parietal gyrus and right inferior temporal gyrus. There were no significant differences in TBSS or probabilistic tractography.

These results indicate cerebral pain processing in ONFH patients. It is advantageous to use functional magnetic resonance imaging to better understand pain pathogenesis and identify new therapeutic targets in ONFH patients.

• Diffusion tensor imaging
• Functional magnetic resonance imaging
• Functional plasticity
• Osteonecrosis of the femoral head
• Pain

• Core decompression
• IL4
• Immunomodulation
• Mesenchymal stromal cells
• Osteonecrosis
• Preconditioning

• ARCO, Association Research Circulation Osseous
• BMES, Bone marrow oedema syndrome
• CT, Computed tomography
• DSA, Digital subtraction angiography
• Diagnosis
• Guideline
• MRI, Magnetic resonance imaging
• ONFH, Osteonecrosis of the femoral head
• Osteonecrosis of the femoral head (ONFH)
• PET, Positron emission tomography
• RHS, Reconstruction Hip Scores
• SPECT, Single-photon emission computed tomography
• T1WI, T1-weighted images
• Treatment

Various pharmacological treatments have been suggested to treat osteonecrosis of the femoral head. However, their practicability remains a controversial issue.

We systemically reviewed articles published during last 20 years to assess the efficacy and safety of the pharmacological treatments.

To date, enoxaparin, statins, bisphosphonates, iloprost and acetylsalicylic acid have been practiced for the treatment of osteonecrosis. However, none of them were proven to be effective by high level studies, and most of them have adverse reactions.

No pharmacological prevention or treatment of osteonecrosis is recommendable at this moment.

• Bone remodeling
• Diphosphonates
• Drug therapy
• Osteonecrosis

Femoral head collapse is a key reference point for determining a treatment regimen of femoral head osteonecrosis. However, there are no effective preventive measures and the efficacy of hip-preserving surgery is unsatisfactory due to the unclear mechanism of collapse. This study aimed to identify and validate miRNAs differentially expressed in collapse and non-collapse areas of the osteonecrotic femoral head, and to predict the target genes and pathways of these miRNAs.

Nine samples passed the quality control test. A total of 2085 differentially expressed miRNAs were detected, among which 433 miRNAs showed differential expression in the T1 group compared to the W1 group; 344 miRNAs showed differential expression in the T2 group compared to the W2 group; 107 miRNAs showed differential expression in the T3 group compared to the W3 group. After combining data from all three patients, 10 miRNAs showed differential expression in the collapse area (T1+T2+T3) compared to the non-collapse area (W1+W2+W3). Compared to the normal area, has-miR-195-5p showed the most significant downregulation. Expression results from RT-PCR revealed that the expression of hsa-miR-195-5p in the collapse area (T1+T2+T3) was significantly lower than that in the non-collapse area (W1+W2+W3) and normal area (Z1+Z2+Z3). 157 genes were perdicted as the target gene of hsa-miR-195-5p.

Femoral heads of three patients (2 males and 1 female) treated by total hip arthroplasty surgery for steroid-induced femoral head osteonecrosis were selected based on inclusion and exclusion criteria. Bone tissue samples were obtained from the collapse area (T), non-collapse area (W), and normal area (Z) according to the anatomical structure of osteonecrotic femoral heads. Total RNA was extracted from the samples and the microarray chip was scanned. miRNAs showing differential expressions of more than 1.5-fold were selected and was validated by RT-PCR. TargetScan, mirBase and miRanda bioinformatics software was used to predict target genes and identify possible pathways involving these genes.

miR-195-5p showed the most significant difference in the collapse area of osteonecrotic femoral heads, suggesting that collapse may be related to the downregulation of miR-195-5p.

• downregulated
• femoral head collapse
• miR-195-5p
• osteonecrosis

We aimed to investigate whether and how corticosteroid use was associated with serious hip arthropathy.

This population-based cohort study analyzed the Taiwan National Health Insurance Research Database and screened the one-million random sample from the entire population for eligibility. The steroid cohort consisted of 21,995 individuals who had used systemic corticosteroid for a minimum of 6 months between January 1, 1997 and December 31, 2006. They were matched 1:1 in propensity score on the index calendar date with controls who never used steroid. All participants were followed up until occurrence of serious hip arthropathy that required arthroplasty, withdrawal from the national health insurance, or the end of 2011. Surgical indication was classified as fracture-related and -unrelated. The cumulative incidence of hip arthroplasty was estimated by the Kaplan Meier method. The association with steroid exposure was explored by the Cox proportional hazard model.

Cumulative incidences of hip arthroplasty after 12 years of follow-up were 2.96% (95% confidence interval [CI], 2.73–3.2%) and 1.34% (95% CI, 1.2–1.51%) in the steroid users and non-users, respectively (P<0.0001). The difference was evident in fracture-related arthroplasty with 1.89% (95% CI, 1.71–2.09%) versus 1.10% (95% CI, 0.97–1.25%), but more pronounced in fracture-unrelated surgery, 1.09% (95% CI, 0.95–1.24%) versus 0.24% (95% CI, 0.19–0.32%). Multivariate-adjusted Cox regression analysis confirmed steroid use was independently associated with both fracture-related (adjusted hazard ratio [HR], 1.65; 95% CI, 1.43–1.91) and unrelated arthroplasty (adjusted HR, 4.21; 95% CI, 3.2–5.53). Moreover, the risk for fracture-unrelated arthropathy rose with steroid dosage, as the adjusted HR increased from 3.30 (95% CI, 2.44–4.46) in the low-dose subgroup, 4.54 (95% CI, 3.05–6.77) in intermediate-dose users, to 6.54 (95% CI, 4.74–9.02) in the high-dose counterpart (P_trend<0.0001).

Corticosteroid use is associated with long-term risk of hip arthroplasty, particularly for fracture-unrelated arthropathy.

• Fast MRI sequences
• Hip osteonecrosis
• Multifocal osteonecrosis
• Osteonecrosis

• Adult
• Aged
• Arthroplasty, Replacement, Hip/methods
• Female
• Femur Head Necrosis/etiology
• Femur Head Necrosis/surgery
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Postoperative Complications
• Reoperation
• Retrospective Studies